[Simultaneous VMAT for Multiple Hepatic Metastases Resulting in Disease Control in a Super-Elderly Patient with...

A man in his 90s with a history of gastrectomy for gastric cancer was diagnosed in December of year X with a circumferential transverse colon carcinoma causing endoscopic obstruction. He underwent laparoscopic partial resection the following month. Pathology revealed a 65×35 mm tumor(tub1-pap>tub2), corresponding to pStage Ⅱa. His carcinoembryonic antigen(CEA)dropped from 11.0 ng/mL preoperatively to 2.9 ng/mL postoperatively. By August of the same year, CEA levels began to rise again. Magnetic resonance imaging detected three hepatic metastases. A 10 mm lesion in segments 5 lay adjacent to the right hepatic vein, predicting substantial surgical invasiveness. Because pre-existing pancytopenia contraindicated chemotherapy, which the patient also declined, radiotherapy was selected. Two months later, all 3 lesions were treated simultaneously with volumetric-modulated arc therapy(VMAT)(60 Gy/20 fr), completed without toxicity. CEA declined from 71.9 to 3.5 ng/mL within 2 months post-irradiation. One-year post-radiotherapy, a gradual CEA increase together with FDG-PET/CT and MRI findings suggested local recurrence;nevertheless, disease activity remained contained while the super-elderly patient retained independent activities of daily living.